Should new antiviral treatments be considered in elderly Chronic Hepatitis C patients?

Background A relevant proportion of patients affected by Chronic Hepatitis C (CHC) is older than 65 years. New antiviral treatments provide for the first time the possibility to treat and cure these patients. However, some clinical aspects proper of elderly, such as frailty, may affect general, non liver-related outcomes, reducing the clinical benefit of virological clearance. We assessed the cost-effectiveness of new antivirals taking into account the severity of liver disease, the patients’ age and the geriatric (frailty) status. Methods A Markov model of CHC natural history was built. The study focuses on CHC patients older than 65 years, stratified according to liver fibrosis (METAVIR F3 and F4), age (65 to 85 years old) and frailty phenotype defined by Fried’s (notfrail, pre-frail and frail) for a total of 30 cohorts simulated. Treatment with sofosbuvir plus simeprevir (SOF/SMV) combination versus no treatment was assessed for each cohort population. Results are presented as incremental costeffectiveness ratios (ICERs) per QALY gained using a lifetime time horizon and the Health System perspective. A sensitivity analysis was performed to assess the robustness of results. Results At each fibrosis score, ICER increased with age and frailty index. In F3 cohorts ICER was below E37,000/QALY up to age 75 in frail patients, up to age 78 in pre-frail patients, up to age 82 in not-frail patients. In F4 cohorts ICER was below E37,000/QALY up to age 78 in frail patients, up to age 82 inpre-frail patients, up to age 85 in not-frail patients. The sensitivity analyses confirmed the significant impact of frailty on the cost-effectiveness of SOF/SMV. Conclusions The cost-effectiveness of SOF/SMV in elderly CHC patients is affected by the severity of liver disease, the patients’ age and the frailty phenotype. A careful assessment of the patient geriatric status is mandatory to better allocate the resources available to treat the elderly CHC patients. Key messages Anti-HCV treatment should be considered in elderly patients Severity of liver disease, patients’ age and frailty must be considered together to better allocate the resources for HCV treatment